MEDICARE: APURVA PATEL I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	50027	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82-1111439	OTHER	CA	EMPLOYER INDETIFICATION NUMBER
2	50027	OTHER	CA	STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1154896223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APURVA PATEL I

Provider Business Mailing Address
First Line	:	1535 E HIGHLAND AVE STE A
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4682
Country	:	US
Telephone Number	:	909-881-0088
Fax Number	:	909-881-0055

Provider Business Practice Location Address
First Line	:	1535 E HIGHLAND AVE STE A
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4682
Country	:	US
Telephone Number	:	909-881-0088
Fax Number	:	909-881-0055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	10/04/2018

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Directions to “ APURVA PATEL I ” Practice Location

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